I. Overview of gingival hyperplasia: Is an enlargement of the gingival tissues caused from the proliferation of the gingival epithelium and underlying connective tissue.
II. Medical history: Patient is a 30 year old male that has been visiting his physician regularly for a history of having seizures with a history of high blood pressure. He is currently taking phenytoin as an anticonvulsant and Nifedipine, a calcium channel blocker for his blood pressure. The patient was sent to our office as a referral because he hasn't been seen by a dentist in over 5 years.
III. Provide a gingival description utilizing the picture (refer to photo above): The free gingiva appears generalized erythematous, scalloped-shaped with no architecture, blunted, bulbous, with localized clefting on #25, edematous, shiny, and localized fibrotic tissue interproximal #21-22 and 27-28. The attached gingiva appears erythemic with possible hemorrhage, fibrotic, with loss of stippling, and shiny.
IV. Assessment findings:MBI 86% and BOP 90%. Probing depths are generlized 4-5mm with localized pseudopockets of 6mm. No areas of recession as of yet, possibly after treatment this assesment will change and no furcations noted. Pl is 100%. Mobility is (+) #6-11 and #23-27. Fremitus is (+) 6-12. Salivary flow is inadequate. RCC Calculus Code is Full Mouth Medium.
V. OHI: We would go over the bass technique with this patient. We would strongly advise them to use an extra soft toothbrush. This would help reduce the risk of additional irritation during brushing from his highly inflammed tissue. With doctors advisement, we would also recommend an at-home antimicrobial irrigation (CHX) to reduce gingivitis, plaque and calculus, bleeding on probing, probing depths, periodontal pathogens, and inflammatory mediators. This would result in a shorter healing time and a reduction in pain. These would be the initial steps we would implement into this patients OHI. At the patients next appointment we would re-evaluate the compliance and effectivness of the oral hygiene instructions implemented.
Treatment Plan: Appt. 1
Periodontal Assessments
FMX DDS exam
2nd check
PI/OHI
Appt. 2
review OHI
scaling and root planning URQ with anesthesia and chlorohexadine irrigation
Appt. 3
review OHI
scaling and root planning LRQ with anesthesia and chlorohexadine irrigation
Appt. 4
review OHI
scaling and root planning ULQ with anesthesia and chlorohexadine irrigation
Appt. 5
review OHI
scaling and root planning LLQ with anesthesia and chlorohexadine irrigation
Appt. 6
4-6 week re-eval
Appt. 7
3 month recall
VII. Additional treatment: If gingival enlargement persists periodontal surgery is indicated: periodontal flap would be recommended because it involves >6 teeth.
VIII. Multiple Choice Questions:
1. Chlorhexidine when used after treatment, as an at-home irrigation, provides the following benefits EXCEPT:
a. Reduces plaque and calculus
b. Reduces healing time
c. Is contraindicated for this patient
d. Reduces periodontal pocket depth
2. What systemic illness would this patient most likley be experiencing?
a. Diabetes
b. Siezures
c. Hypothyroidism
d. Hypertension
3. What is the possible prognosis for this patient?
a. poor
b. good
c. fair
d. hopeless
4. Gingival hyperplasia is caused from an enlargement of gingival tissue caused by a proliferation of tissue?
a. True
b. False
5. What are the causes of the erythematous free gingiva?
a. Excessive collagen production
b. Increased in vascularity
c. Loss of rete pegs
d. None of the above
6. High MBI is an indication of exceptional health:
a. False
b. True
7. Inadequate salivary flow is a perpetuating factor in this patient's periodontal health:
a. True
b. False
8. What other referrals could be recommended to this patient?
a. Referral to an orthodontist for braces
b. Referral to a periodontist for gingival flap surgery
c. No referrals are necessary
9. Gingival contouring prevent future overgrowth
a. True
b. False
10. Which medications would NOT be the likely cause in this patient's gingival overgrowth?
a. Phenytoin
b. Dilantin
c. Nifedipine
Case #1 - Hyperplasia
I. Overview of gingival hyperplasia: Is an enlargement of the gingival tissues caused from the proliferation of the gingival epithelium and underlying connective tissue.
II. Medical history: Patient is a 30 year old male that has been visiting his physician regularly for a history of having seizures with a history of high blood pressure. He is currently taking phenytoin as an anticonvulsant and Nifedipine, a calcium channel blocker for his blood pressure. The patient was sent to our office as a referral because he hasn't been seen by a dentist in over 5 years.
III. Provide a gingival description utilizing the picture (refer to photo above): The free gingiva appears generalized erythematous, scalloped-shaped with no architecture, blunted, bulbous, with localized clefting on #25, edematous, shiny, and localized fibrotic tissue interproximal #21-22 and 27-28. The attached gingiva appears erythemic with possible hemorrhage, fibrotic, with loss of stippling, and shiny.
IV. Assessment findings: MBI 86% and BOP 90%. Probing depths are generlized 4-5mm with localized pseudopockets of 6mm. No areas of recession as of yet, possibly after treatment this assesment will change and no furcations noted. Pl is 100%. Mobility is (+) #6-11 and #23-27. Fremitus is (+) 6-12. Salivary flow is inadequate. RCC Calculus Code is Full Mouth Medium.
V. OHI: We would go over the bass technique with this patient. We would strongly advise them to use an extra soft toothbrush. This would help reduce the risk of additional irritation during brushing from his highly inflammed tissue. With doctors advisement, we would also recommend an at-home antimicrobial irrigation (CHX) to reduce gingivitis, plaque and calculus, bleeding on probing, probing depths, periodontal pathogens, and inflammatory mediators. This would result in a shorter healing time and a reduction in pain. These would be the initial steps we would implement into this patients OHI. At the patients next appointment we would re-evaluate the compliance and effectivness of the oral hygiene instructions implemented.
Treatment Plan:Appt. 1
Appt. 2
- review OHI
- scaling and root planning URQ with anesthesia and chlorohexadine irrigation
Appt. 3Appt. 4
Appt. 5
Appt. 6
Appt. 7
VII. Additional treatment: If gingival enlargement persists periodontal surgery is indicated: periodontal flap would be recommended because it involves >6 teeth.
VIII. Multiple Choice Questions:
1. Chlorhexidine when used after treatment, as an at-home irrigation, provides the following benefits EXCEPT:
a. Reduces plaque and calculus
b. Reduces healing timec. Is contraindicated for this patient
d. Reduces periodontal pocket depth
2. What systemic illness would this patient most likley be experiencing?
a. Diabetes
b. Siezures
c. Hypothyroidism
d. Hypertension
3. What is the possible prognosis for this patient?
a. poor
b. good
c. fair
d. hopeless
4. Gingival hyperplasia is caused from an enlargement of gingival tissue caused by a proliferation of tissue?
a. True
b. False
5. What are the causes of the erythematous free gingiva?
a. Excessive collagen production
b. Increased in vascularity
c. Loss of rete pegs
d. None of the above
6. High MBI is an indication of exceptional health:
a. False
b. True
7. Inadequate salivary flow is a perpetuating factor in this patient's periodontal health:
a. True
b. False
8. What other referrals could be recommended to this patient?
a. Referral to an orthodontist for braces
b. Referral to a periodontist for gingival flap surgery
c. No referrals are necessary
9. Gingival contouring prevent future overgrowth
a. True
b. False
10. Which medications would NOT be the likely cause in this patient's gingival overgrowth?
a. Phenytoin
b. Dilantin
c. Nifedipine
**Answer page**